Exam Questions Flashcards
Upper respiratory tract infections are mostly caused by which of the following:
virus
Exposure to volatile chemicals found in cigarettes is the main cause of emphysema.
true
This middle respiratory tract infection causes inflammation to the larynx and a barking cough in infants:
croup
Enlarged airspaces beyond the respiratory tubules are a way of describing which of the following?
emphysema
What mineral do patients with cystic fibrosis have trouble reabsorbing?
chlorine
Which of the following is the most common cause of a pulmonary embolism?
DVT
Antibiotics are NOT a treatment for which of the following pathologies:
common cold
Excessive production of mucus in the lumen of the bronchioles causing cough and expectoration for at least 3 months during the last 2 years is called:
chronic bronchitis
Primary tuberculosis is clinically unrecognized 95% of the time.
true
The treatment of asthma is considered symptomatic.
true
Sarcoidosis is a disease that affects more than one organ/system.
true
Smoking is the cause, for most cases of primary lung cacinoma.
true
Exposure to asbestosis may cause lung cancer.
true
Respiratory infections are not that common.
false
The most common method of transmission of the common cold are:
respiratory droplets
Which of the following is the most common cause of allergic rhinitis?
pollen
We suspect a patient may be having an asthma attack if they present with signs and symptoms such as
wheezing, coughing, difficulties breathing
Atelectasis can be caused by a puncture to the pleura surrounding the lung.
true
Lung carcinoma is the most common malignant internal tumor in Canada.
true
Sarcoidosis presents with common signs and symptoms such as:
low grade fever and weight loss
Allergic rhinitis presents with:
nasal irritation
congestion
sneezing
A sleep disorder is which breathing stops and starts repeatedly.
sleep apnea
When an infant is born prior to 32 weeks and does not produce surfactant which respiratory disease do they have?
neonatal respiratory distress syndrom
A common term for atelectasis is which of the following?
collapsed lung
What is the catch all term of lung diseases caused by obstruction of the airways?
COPD
The following are all intrinsic factors of asthma except:
exposure to exogenous allergens
Pott’s disease presents with this common symptom seen by massage therapists:
back pain
Injury to the alveolar lining cells or endothelial cells is which of the following pathologies?
acute respiratory distress syndrome
Lung cancer originating from the lungs is more common than metastasis from other sites.
false
The most common cause of pneumonia is which of the following?
bacteria and virus
A pathological fracture is important to identify because:
The underlying disease must be identified
Which bone when fractured is important to identify with snuff box tenderness due to the risk of poor healing if not casted?
Scaphoid
Which of the following is a known risk factor for the development of osteoporosis?
Smoking
The supplementation of milk with Vitamin D is done to prevent which disease?
Osteomalacia
Which of the following is a risk factor for the development of osteoarthritis?
Obesity
Which metabolic product is the underlying problem in gout?
Uric acid
When surgery is required to align the bony pieces of a fracture it is called:
Open reduction
An imbalance between the synthesis and degradation of cartilage is the underlying cause of which disease?
Osteoarthritis
A person has a fall and their leg is externally rotated and shortened. What type of fracture is likely?
Hip
Congenital ‘brittle bone disease’ is known as:
Osteogenesis imperfecta
A 19-year-old man presents to his doctor with chronic knee pain and is eventually diagnosed with cancer. Which type of cancer best fits this presentation?
Osteosarcoma
Which two concurrent complaints go with discitis?
Back pain and fever
Which one of the following is a fracture associated with osteoporosis?
Compression fracture
Rheumatoid nodules are:
Granulomas found on extensor surfaces
Bacterial infection of the bone is known as:
Osteomyelitis
Rickets is known as:
Osteomalacia
The process during which bones forming a joint lose contact and become misaligned is known as which of the following?
Dislocation
Which joint in the body must be managed very carefully when a massage therapist is treating a person with Rheumatoid Arthritis
C1 - C2
One of your clients has been seeing you for pain in her leg for 6 treatments and has noticed no difference in her problem. On her 6th visit she reports suffering from fatigue and believes she is losing weight. Which referral is most appropriate?
Medical Doctor
Rheumatoid arthritis is a multi-system disease that involves more than just joints.
True
You observe a person drinking coffee and their hands look very malformed. They appear to have ulnar deviation of their wrists with swan neck deformities of their fingers. You think this person suffers from:
Rheumatoid arthritis
Which of the following presentations is more likely rheumatoid arthritis?
Symmetrical joint involvement
Which of the following is NOT a joint usually affected by degenerative joint disease (osteoarthritis)?
Elbow
[It affect weight bearing joints]
For any bone to heal properly it is important to have just the right amount of:
Load
Which disease is defined as the loss of bone mass / density?
Osteoporosis
The loss of continuity of the structure of a bone is known as:
Fracture
Which of the following should be considered a medical emergency?
Septic arthritis
Thickened and deformed bones due to abnormal restructuring of the bone, is characteristic of which disease?
Paget’s
When a fracture fragment penetrates the skin and is exposed to the environment the fracture is referred to as:
Open/compound fracture
Legg-Calve-Perthes disease is a children’s example of which disease of the head of the femur?
Avascular necrosis
Inflammation and pain of the 1st metatarsal phalangeal joint of the foot due to gout is known as:
Podagra
A pathology presenting with heartburn that is worse at night, chest pain, difficulty swallowing, and regurgitating your food is know as:
GERD
Crohn’s Disease often has a delayed diagnosis due to the original symptoms being non specific.
true
Diverticulitis is defined as:
inflammation and infection of the diverticulum
Which type of hernia is most common?
Inguinal
The most likely causes of Cirrhosis is:
Alcohol
Which of the following are forms of Inflammatory Bowel Disease (IBD)
Ulcerative Colitis
Crohn’s Disease
What are the signs and symptoms of Hep B?
Weakness, vomiting, measles like rash, dark urine
Signs and symptoms of a peptic ulcer include
pain 1-3 hours following a meal
The cause of Irritable Bowel Syndrome is unknown.
true
A patient of yours presents with a sudden fever and abdominal pain in the lower right quadrant. You refer to medical attention and suspect:
Acute Apendicitis
Signs and symptoms of gallstones are:
upper right quadrant pain, referred to back and right shoulder, indigestion
Acute Pancreatitis is often linked to which of the following:
Alcoholism
Cryptochidism is?
A congenital malpositioning of the testes outside their normal scrotal location
An STI that can reoccur
Genital herpes
An STI that doesn’t necessarily display signs and symptoms in females
Chlamydia
What is pelvic inflammatory disease?
Infection of the uterus, fallopian tubes or other reproductive organs
What is the current survival rate of testicular cancer?
more than 90%
What is prostatitis?
inflammation of the prostate
what urinary problems are associated with the carcinoma of the prostate?
urgency to void but cannot
What are the signs and symptoms of prostate cancer?
Massage therapist should remember back pain that is
unusual in it’s presentation
What virus is related to cervical carcinoma?
HPV
PAP smears in women decrease which type of cancer in women?
Cervical Cancer
In what stage of life is endometral adenocarcinoma most likely to occure?
Endometrial tumors
generally affects those entering
menopause
What is leiomyoma
Benign tumor originating from the
myometrium
what is endometriosis
Tissues of endometrium found outside
the uterus
what is vulvodynia
chronic pain or discomfort around the opening of
your vagina for which there is no identifiable cause and which
lasts at least 3 months.
the most common site for ectopic pregnancy is
Ampulla of the Fallopian tube
placenta previa is
placenta is covering the opening of
the internal o/s of the cervix.
Fibroadenoma is
Benign Breast Tumor
where are most breast tumors found? why?
45% tumors found in upper lateral quadrant
Where does breast cancer metastases occure
axillary lymph nodes.
Tumors may also metastasize to lungs, liver, brain, bones
and adrenal glands.
what is the clinical presentation of breast carcinoma?
- Breast mass discovered by palpation
- Tumor discovered by mammography
- Pain (mastodynia) or painful breast
mass - Nipple retraction, eczematoid reaction,
or discharge - Distant metastases
- Edema in the arm due to metastases to
lymph nodes.
What is a stroke?
rapid onset of typical
neurological deficits due to injury to the
brain
o Can be due to occlusion of blood vessels,
bleeding, or low blood pressure
what are the causes of ischemic stroke?
Cerebral infarct / ischemic stroke is a stroke
due to occlusion of blood vessel supplying the
affect area of the brain
Caused by thrombotic (atherosclerotic artery)
occlusion or thromboembolic occlusion
(from heart chambers)
What are the signs and symtoms of cerebral infarction? Why is it important to recognise the signs and symptoms early?
Unilateral hemiplegia, loss of sensation, facial
droop, speech difficulties (aphasia), eye
deviation, loss of one side of vision
Recovery depends on amount of brain tissue
damaged
o Ranges from no deficits to death
What are the causes for horner’s syndrome?
stroke, TUMOUR or spinal cord injury.
If underlying condition resolved nerve
function may be restored.
where does the bleeding occur in an epideral hematoma, and subdural hematoma? which vessels have ruptured (generally)?
Epidural Hematomas (meningeal artery)
* Bleeding between the skull and
the dura
Subdural Hematomas (ruptured bridging veins)
* Bleeding located between the dura
mater and the arachnoid
what is the classic presentation of a subarachnoid hemorrhage?
(Aneurysms) Sudden onset of the worst headache of their life with or
without neck stiffness
What is the cause of global ischemia?
Condition that results from short term
drop in blood pressure
what is the type of cells in the CNS that are involved in the primary tumor?
glial cell
What are the most common infective agents in the CNS?
bacteria and
viruses
Define Meningitis
Inflammation of the meninges secondary to
infection
Define encephalitis
Inflammation / infection of brain
parenchyma
what causes poliomyelitis?
Polio
what are the signs and symptoms of poliomyelitis?
slight fever,
malaise, headache, sore throat and vomiting
Nonparalytic: moderate fever, headache, vomiting, lethargy, pain in the
neck, back, extremities and abdomen. Here muscle tenderness, weakness
and and spasms can be seen. Usually lasting 1-2 weeks
Paralytic: usually develops 5-7 days after a fever sets in. Signs and symptoms
similar to nonparalytic but here we see asymmetrical weakness of muscle,
loss of reflexes and paresthesia, eventually leading to paralysis, the level of
which depending on area of spinal column is being affected.
What cranial nerve is involved in bell’s palsy?
seventh cranial nerve
VII FACIAL
What is MS
Chronic debilitating disease thought to be
due to autoimmune process that results in
the patient’s immune system attacking the
myelination of the CNS
Differences between:
myelomeningocele
meingocele
spina bifida
Spectrum of disease that results from
incomplete or improper closure of the ‘neural
tube’ during intrauterine development
Three degrees of same problem
o Myelomeningocele
▪ Defect in back with protrusion of meninges and part
spinal cord
▪ Apparent at birth
o Meningocele
▪ Defect in back with protrusion of meninge
▪ Apparent at birth
Spina bifida
▪ Absence of musculoskeletal elements with possible
exposure of meninges/spinal cord to outside world
cerebral palsy is
A congenital Myopathy
what is the presentation of cerebral palsy?
Presents with floppy child syndrome
* Tremors
* involuntary movement
* Delays in motor and speech development
– Neurogenic atrophy of muscle tissue impairs the ability of the child
to move and many become confined to a wheelchair
how is cerebral palsy treated
supportive and symptomatic
what is a contusion
Bruising and small centers of bleeding in the tissue of the brain
secondary to trauma
what is a coup and a counter coup lesion?
Contusion
Coup - Anterior (SITE OF IMPACT)
Counter coup - Posterior
what is a concussion?
Concussion
▪ Poorly understood complex pathophysiologic process affecting
the brain, induced by traumatic biomechanical forces
what level os the spinal cord involves paralysis of the diaphram?
Injury at C4 level may result in
paralysis of the diaphragm
what is athetosis, dystonia, myoloconus and tics?
Athetosis: a condition in which abnormal muscle contractions cause
involuntary writhing movements. It affects some people with cerebral palsy,
impairing speech and use of the hands.
Dystonia: a state of abnormal muscle tone resulting in muscular spasm and
abnormal posture, typically due to neurological disease or a side effect of drug
therapy. Caused by injury to the basal ganglia
Myoclonus: spasmodic jerky contraction of groups of muscles. Eg. It occurs
just before falling asleep.
Tics: There are two types of tics – motor tics and vocal tics. These shortlasting sudden movements (motor tics) or uttered sounds (vocal tics) occur
suddenly during what is otherwise normal behavior. Tics are often repetitive,
with numerous successive occurrences of the same action. For instance,
someone with a tic might blink his eyes multiple times or twitch her nose
repeatedly
what is the primary symptom os alzheimer’s disease?
Dementia
o progressive loss of cognitive functions and a
functional decline (loss of memory predominates)
List the classic signs and symptoms of parkinson’s disease?
o Pill rolling tremor of hands worse at rest
o Mask like faces
o Soft voice
o Shuffling gait, instability
o Stooped posture
Why is huntinton’s disease often passed on to future generations?
- First symptoms usually do not appear
before midlife
o Results in disease being past on as no
manifestation until later in life
What is amyotrophic lateral sclerosis? Lou Gehrig’s Disease
- Neurodegenerative disease
What are the signs and symptoms of amyotrophic lateral sclerosis?
Lou Gehrig’s Disease
- Motor weakness and progressive
wasting of muscles in the extremities
(small hand muscles)
what is freidreich’s ataxia
neuromuscular disease
that mainly affects the
nervous system (spinal
cord and peripheral
nerves) and the heart
AGE 10-25
what is depression
a mood disorder in which people
show extreme and persistent sadness, despair,
and loss of interest in life’s usual activities.
what is schizophrenia
psychological disorders
characterized by a lack of reality testing and by
deterioration of social and intellectual
functioning and personality beginning before age
45 and lasting at least six months.
what is bipolar disorder
mood disorder that is characterized by
behaviour that vacillates between 2 extremes:
mania and despair.
Head ache red flags
o Headache and fever - ?meningitis, encephalitis?
o Headache and stiff neck - ?meningitis, bleeding?
o Sudden onset of worst headache ever - ?sub
arachnoid bleed?
o Change in headache pattern - ?tumor?
o Headache worse in morning - ?tumor?
o Headache and vomiting - ?increase intracranial
pressure?
o Headache with neurological deficits - ?lesion?
o Headache post fall (especially in elderly, alcoholics,
use of blood thinners) - ? bleeding?
o Headache with fatigue, jaw ache, vision changes -
?temporal arteritis?
should a therapist treat a client with an acute migraine? why or why not?
o Not the treatment for acute severe migraine
o Massage may trigger some
Massage best for tension type headaches
* Migraines may be hit and miss
What is adhesive capsulitis (Frozen shoulder)
shoulder joint capsule thickens and tightens
around the shoulder joint restricting movement.
what is the onset of adhesive capsulitis
sudden or gradual onset
from 45 to 60 years of age if it results
from causes other than trauma. It can occur at any age but
more commonly with increased age.
what ROM’s are most often affected by adhesive capsulitis?
Abduction and External rotation
what are the stages of healing associated with adhesive capsulitis?
1.Freezing (Painful stage)
* Lasts 6 – 12 weeks
* Most painful stage
* ROM is restricted, shoulder not as stiff
2. Frozen
* Pain usually eases
* Considerably more stiff
* Lasts 4 to 6 months
3. Thawing
* Gradually motions steadily improves over a lengthy period of
time
* Can last more than a year
which ion deposits and causes bursitis?
Ca2+ deposits
describe the presentation of acute bursitis?
Pain
with movements of the arm
especially abduction and
rotations.
why is the supraspinatus tendon more prone to tendionitis?
*Most commonly impinged
tendon of the shoulder
*Poor O2
supply along with
amount of use tendon
receives greatly
compromises this tendon
where is the supraspinatus tendon most likely impinged?
between the
acromion and head of
humerus
what are the signs and symptoms of supraspinatus tendonitis?
pain
what motions are most commonly associated with an infraspinatus tendonitis?
sustained abduction, external
rotation and overhead
activities
what motions are most commonly associated with injury to the bicipital tendon?
overhead activities with
incorporation of flexion, and
rotation
what is an impingement syndrome?
compromised space between the
coracoacromial arch and the proximal humerus
what is a sprain?
– injury to a ligament
what is a strain?
injury to a muscle or tendon
why is GH dislocation common?
poor congruency of the
humeral head in glenoid fossa
define epicondylitis of the elbow
overuse injuries, with
progressive tissue degeneration.
what are the structues damaged in lateral epicondylitis of the elbow?
- Characterized with pain on the lateral apsect of the
elbow. Tennis elbow
what are the structures damaged in medial epicondylitis of the elbow
Characterized with pain on the medial aspect of the
elbow. Golfers elbow
what is the presentation of olecranon bursitis?
Pain and swelling in the elbow
what are the signs and symptoms of De Quervian’s tenovaginitis?
pain at snuff box area and
distal lateral forearms with gripping
activities and into thumb. Resisted
thumb extension and abduction
increase pain, positive Finkelstein’s
test.
what is Dupuytren’s contracture?
contracture of the palmer aponeurosis.
What is a cervical strain?
an injury or impairment of the cervical region of the
spine due to overuse or overextension ”
what is an acceleration injury?
Whiplash
What is a deceleration injury?
Whiplash
what are the questions you would ask some one involved in a car accident?
Head position
Height of passenger
Seat position
Headrest position
Speed and direction involved
* Rear, side or frontal impact
* What happened during the accident?
* Did you hit your head, loose glasses, dentures?
* Aids in determining severity of movement
* Where were you located in the vehicle?
* Passenger, driver, etc.
* Were you wearing your seatbelt
* Were you aware of the impending accident
describe WAD 1
Complaint of neck pain, stiffness or tenderness
only; no physical (musculoskeletal or
neurological) signs; no muscle spasm
Describe WAD 2
Complaint of neck pain, stiffness or tenderness;
decreased ROM and point tenderness; injury to
muscles, tendons, ligaments and joint capsules,
causing muscle spasm
Describe WAD 3
Complaint of neck pain, stiffness or tenderness;
neurological signs including decreased or
absent tendon reflexes, weakness and sensory
deficit
describe WAD 4
Complaint of neck pain and fracture or
dislocation
what are the symptoms of a cervical strain?
sharp pain, stiffness when moving and
swelling.
correlate the WAD injury to the type of accident?
- Collision types
- Type 1 collision: Rear impact
- Type 2 collision: Side impact
- Type 3 collision: Frontal impact
Also gives stages of healing
- Stage 1: Acute injury, inflammation phase, up to 72 hours postaccident.
- Stage 2: Sub acute, repair phase, 72 hour to 14 days.
- Stage 3: Remodelling phase, 14 days to 12 months or more.
- Stage 4: Chronic, permanent.
Does being aware of the accident increase your injury rate? why?
Injury is less severe if the person does not see the injury coming and is not
bracing for impact.
what is the rate of MVA that result in cervical fractures?
80 % of all cervical fractures are due to MVA
Before treating some one with a MVA, the clients should
When dealing with any rapid velocity injury it is
imperative that the patient have an x-ray to rule
out fracture.
what screening tests should be done prior to commencing any massage treatment?
Questions/history/mechinism of injury
VBI/ROM/Cervical palpatory assessments
which tests involve testing neurological structures in the Cervical spine?
Compression, decompression, spirlings, quadrant, maxmal foraminal
Describe the symptoms of toritcollis?
abnormal
positioning of the head and neck realtive
to the body.
Congenital tortocollis
* Treatment
– When found a birth, ROM exercises with toys
to utilize the visual reflex will assist in
stretching the affected musculature.
– Surgery may be required to removed severly
fibrotic tissues. Post surgery active pain free
ROM are acceptable and recommended.
Acute acquired tortocollis
* Symptomology
– Can affect any age
– Sudden onset, patient my report just “waking up like
this”
– Head and neck are in typical “tortocollis” position
– Decreased ROM in SB away from affected side and
rotation towards affected side. There may also be
some neck flexion or extension
– Pain, especially on movement. Patients often do not
want to move head as it provokes great pain.
define acute tubular necrosis
occurs after cardiac arrest
and any form of Hypotensive shock
(massive bleeding)
what is nephroangioslcerosis?
Atherosclerosis of major arteries (aorta
and major branches of the renal artery)
may lead to decreased lumen and thus
decreased blood flow to kidneys.
what is Wilm’s tumor?
Tumor of infancy and childhood
* Malignant tumor
What is the age group affected by wilm’s tumore?
children
What is the cause of most urinary tract infections
bacteria
what is the most common form of UTI’s
Ascending Infections
list the signs and symptoms of a bacterial infection of the kidney?
– fever, back pain over the kidneys, dysuria,
hematuria, and frequency are possible but
not necessary
what are urinary stones>
crystalline structure of
material that the kidneys usually excrete in
urine.
are urinary stones more common in men or women?
More common in men
what are the signs and symptoms of urinary stones?
Severe and unrelenting pain
* Pain is caused by the stretching of the ureter due to the obstructing stone
– Hematuria
– Urinary colics (spasm of ureters)
What is the potential danger of treating a patient with bilateral leg swelling, for a massage therapist?
we need to recognize
that we should not
attempt to change that
swelling as we may
overload the CV system
and stress the patient.
define urinary incontinance
Inability to retain urine in the
urinary bladder.
What are the categories of pituitary disease?
hyperfunction, hypofunction and localized mass lesion
what are the signs and symptoms of acromegaly
- Acromegaly (Post-puberty)
– Enlargement of acral parts of
the extremities (FINGERS, TOES, HANDS, TOUNGUE , JAW AND NOSE)
– Enlarged internal organs
(heart)
– Metabolic disturbances (mass
effects)
– Headaches (mass effects)
what are the differences between gigantism and acromegaly?
- Gigantism (Pre-puberty)
– Longitudinal skeletal growth
what is diabetes insipidus?
Endocrine disorder of the
posterior pituitary affecting the
metabolism of water in the
body (lack of ADH)
CAUSED BY DECREASED BLOOD FLOW TO THE PITUITARY GLAND
what are the signs and symptoms of diabetes insipidus?
– Polydipsia (excessive thirst)
– Polyuria (excessive urine
production)
– Dehydration
What is empty sella syndrome and what is the cause?
disorder in which part of the skull where the pituitary gland is housed (sella turcica) is partially or fully filled with CSF (cerebrospinal fluid)
* Causes: Most are unknown (this is called Primary Empty Sella Syndrome, some are due to underlying
conditions (this is called Secondary Empty Sella
Syndrome)
what are the causes of hyperthyroidism?
excess of thyroid hormones t3 t4
EXCESS OF FSH
what is the cause of Grave’s disease?
Antibodies to the TSH
receptor on the surface of
the follicular cells which
stimulate production of
thyroid hormones.
what is the unique sign and symptom of grave’s disease?
Bulging eyes (Only occurs with Graves
Disease and not other types of
hyperthyroidism)
Massage Considerations
* Heat intolerance
define thyroid adenoma
Benign tumor of the
thyroid gland
Most adenomas are small,
well encapsulated with
fibrous tissue
composed of thyroid
follicles
what is hashimoto’s disease?
– Thyroiditis—Hashimoto’s disease
* Often immune mediated
Slowly developing persistent
inflammation of the
thyroid gland
Autoimmune Disease
what is a risk factor for thyroid carcinoma?
nuclear radiation
Disturbances in the parathyroid can cause problems with what?
Bones are prone to fracture due to
decalcification.
What is the cause of hyperaldosteronism?
in Calcium
Homeostasis
what is the cause of the majority of endogenous hypercoritisolism?
hypersecretion of
ACTH due to pituitary adenoma in
endogenous hypercotisolism
what is the most common cause of hypercortisolism?
- Exogenous steroids is the most
common cause of hypercortisolism.
MOST CASES ARE DUE TO A PITUITARY ADENOMA
What are the signs and symptoms of hypercortisolism?
Cushings Syndrome
* Central trunk obesity
* Moon Face
* Buffalo hump
* Striae of Skin (stretch marks)
* Pt’s red in face b/c of lots
blood, hypertension and thin
skin
* Glucose intolerance, diabetes
* Fatigue
* Mentally unstable
What are the signs and symptoms of addisons disease?
- Fatigue
- Weight loss
- Nausea
- Hyperpigmentation of skin
- Hypotensive
- Syncope (loss of consciousness b/c
of fall of bp)
Massage Considerations: - Extremely susceptible to infections
- Cannot tolerate stress or maintain
many of the usual daily routines - Low NaCl, high K+ and low glucose
What is neuroblastoma?
Tumor composed of
neuroblasts
(undifferentiated
precursor of neural
cells as well as
adrenal medullary
cells)
What are the signs and symptoms os pheochromocytoma?
(Benign solid tumor
originating from the
adrenal medulla)
- Hypertension
- Light headed, dizziness
- Heart lesion due to exposure to epinephrine and norepinephrine.
what is diabetes mellitus
Is a consequence of absolute or relative
insulin deficiency or an abnormal
response of target tissues to insulin.
what is the cause of majority of the signs and symptoms of pheochromocytoma?
exposure to epinephrine
and norepinephrine.
what are the signs and syptoms of low blood pressure
fainting
what considerations should a therapist consider when treating a diabetic client?
Massage Consideration
If patient presents with the following during a treatment
their blood glucose levels are high or hyperglycemia
– Sweet smelling breath (Ketoacidosis)
– Pt may smell like they have been drinking alcohol
– Lots of free fatty acids oxidized to ketones (acidic)
* If patient glucose levels are low or hypoglycemia
– Slurred Speech, dizziness, weakness, pallor, rapid heart rate,
excessive sweating.
– Have juice in clinic
– If pt’s blood glucose levels fall too far they may lapse into a
Diabetic Coma (Call Ambulance)
What are the signs and symptoms of an insulinoma?
- Hypoglycemia, syncope ( fainting after drop in
bp) - Profuse sweating, especially after fasting
- Tx with surgery
Gastrinomas (Malignant)
Signs and symptoms - Peptic Ulcers
What is Idiopathic lower back pain?
- LBP of a musculoskeletal origin (soft tissue
damage) - Otherwise known as mechanical back pain
will mechanical back pain resolve on its own?
- Usually
what is the cause of majority lower back pain?
due to soft tissue
problems (muscle or ligament strain, postural
abnormalities, poor muscle tone or neuromuscular
disease)
how does a massage therapist manage and treat lower back pain?
Management and treatment
* Screen for more sinister diseases that present with back pain
* Cancer, osteomyelitis, osteoporosis, abdominal aortic aneurysm, kidney
disease, cauda equina syndrome, disc prolapse
* Do not over investigate
* X rays not generally helpful – almost everyone has ‘degenerative changes’ but
not everyone has back pain
* Reassure and manage symptoms
* Emphasis on transient nature of the problem while providing pain relief
* Address underlying weakness, flexibility, and weight problems
* Often recurrence can be minimized by addressing these common problems
* Early return to work
* Studies show excessive rest is detrimental to the patient
* Returning to work in any capacity improves outcomes
* If light duties are available they should be pursued and the patient sent
back to work on a progressive schedule targeted to complete duties as an
eventual goal
what are the risk factors of lower back pain?
- Gender
- Repeatedly lifting of heavy objects
- Weak core musculature
- Adaptive muscle shortening due to static posture
- Coughing
- Disk degeneration
- Osteoporosis
- Spondylolisthesis
Undertaking activity beyond physical limitations
will be a large factor in contributing to LBP
-changes in posture
what is the correlation between activity levels and physical ablilities with reference to lower back pain?
Undertaking activity beyond physical limitations
will be a large factor in contributing to LBP
should a therapist change postural deformities? why or why not?
- Changes in this may create LBP
To summarize not all cases of postural deformities will
result in LBP
Should employees return to work early? why or why not?
- The longer someone is off work with back pain, the lower
the probability that they will return to work.
list the factors that attribute to delayed return to work?
- Thoughts that the pain is work related
- Psychologic distress
- Psychosocial aspects of work
- Compensation
- Time off work
define spinal stenosis?
abnormal narrowing of the spinal canal (central) or
intervertebral foramen (lateral).
does loss of bone mass from osteoporosis cause lower back pain? what does?
- Loss of bone does not cause LBP, the associated fractures
or collapse of vertebra can cause. - Treatment concentrated on pain reduction, increasing
exercise and functional activities. (weight bearing exercise) - Important for the patient to maintain bone mass, strength
training, postural stability and reduce pain.
what is a myotome?
muscles innervated by a single spinal nerve.
* To complete the testing the contraction must be held for a
minimum of 6 seconds to show weakness. Testing must be
compared bilaterally, however for safety reasons it is best to
complete the tests on each side separately
What is the reccomended treatment for a patient with osteoporois?
- Treatment concentrated on pain reduction, increasing
exercise and functional activities. (weight bearing exercise) - Important for the patient to maintain bone mass, strength
training, postural stability and reduce pain. - For the elderly, minimizing the risk of falls is important
why is myotome testing unilateral for the lower extremity?
safety reasons it is best to
complete the tests on each side separately
what should you do if the pain does not correlate with assessment findings?
encourage our
patient to see their physician.
list come possible sinister causes of back pain?
- Aortic Aneurysms
- Paget’s Disease
- Prostate Cancer
- Bone Cancer
- Kidney Stones
- Many urinary pathologies present with “flank pain”
what is the structure of intervertebral discs?
- Annulus fibrosus: outer laminated portion of disc made up of 3 zones: An outer zone made up of fibrocartilage
- End plate: is attached to the vertebrae and the
intervertebral discs. It is made up of a bilayer of
bone and cartilage. - Nucleus pulposus: Inner part of intervertebral discs. At birth
it is made up of hydrophilic mucoid tissue which is gradually
replaced by fibrocartilage with age
how do intervertebral discs degenerate?
Degenerative changes occur with age. Discs breakdown with
age thru loss of fluid tears or cracks in annulus fibrosus. Discs
shrink.
Define buldged disk
Protrusion/bulge of disc: disc bulges posteriorly without
rupture of the annulus fibrosus.
define herniated disc
- Extrusion/herniation: the annulus fibrosus is perforated and discal material (part of nucleus pulposus) moves into the
epidural space.
define sequestered dics
- Sequestrated disc: formation of discal fragments from the
annulus fibrosus and nucleus pulposus outside the disc
proper
where does the spine have a increased susceptibility to disc herniation?
Cervical and lumbar regions of the spine
are most susceptible to herniation due
to the increase in flexibility in these
areas.
define referred pain
- Pain originating from deep visceral structures
that is perceived to come from somatic
structures that share the same spinal segment
how is sclerotomal pain described by the patient?
- Usually described as deep aching and diffuse
what are the causes of sclerotomal pain?
an injury of paraspinal muscles, ligaments, facet
joint capsules, discs or the dura mater
what causes redicular pain?
- Due to irritation of the spinal nerve root
- If sensory (dorsal) root is irritated the patient often
experiences sharp pain, numbness or tingling that is well
localized
how does client describe radicular pain?
pain, numbness, tingling there may be weakness
in muscles supplied by that nerve root. Reflexes would also
be decreased by this.
Muscle strain
Cause
Symptoms
signs
- Cause: Acute injury - such as sports, cumulative stress (standing at
work) - Symptoms: diffuse and achy pain – bilateral or unilateral. Stiff and
tight muscles reported by patient, especially with certain movements.
Rest relieves pain. Acute problem – muscle spasm - Signs: Restricted ROM, Point tenderness, Passive motion not usually
painful until full stretch is introduced
Ligament sprain
causes
symptoms
signs
Cause: Are the same as muscle strain
Symptoms: Well localized pain and can be sharp in certain movements
Sign: Active and passive movements are painful. Resisted is not usually
painful
Takes longer to heal
Fibrosis may occur and feel like a thickening in lumbar fascia
* Grade of strains
* Grade I is stretching of the ligament or a very mild tear, with little or no instability at
the joint.
* Grade II is a more serious but still incomplete tear, with some looseness in the joint.
* Grade III is a completely torn or ruptured ligament. This is not a broken bone, but
can feel like one since it’s often impossible to put weight on the joint or use the
affected limb because the joint isn’t
facet dysfunction
causes
symptoms
signs
Cause: Poor posture, muscle imbalance, muscle hypertonicity leading to
fatigue and deconditioning, subluxation, fixation, entrapped meniscoid
Symptoms: May be ‘painless’ to patient, May be sudden onset or
insidious, unilateral or bilateral, Can radiate to groin, gluteal or thigh
Signs: Decreased extension/side-bending and rotation, Palpation of
‘displaced’ bony anatomy (prominent TP), Hypertonicity and tenderness in
muscles of paravertebral spine
SI joint dysfunction
causes
symptoms
signs
Cause: injured by trauma, such as a fall in buttock, repetitive
twisting motion such as in golf.
Risk Factors: leg length discrepancy, muscle imbalances, sustained
muscle tightness
Symptoms: pain in gluteal, groin and posterior thigh,Dull, sharp or
aching pain, Sometimes pain can radiate to below the knee
Signs: Pelvis malalignment. Subluxation, innominate rotation,
flares. Sacral dysfunction (torsions), positive Patrick’s
Piriformis syndrome
causes
symptoms
signs
- Causes: hypertonic piriformis mm. often caused by excessive sitting, SI
joint dysfunction; or overuse resulting from pelvic obliquity that leads
to weakness of the gluteus medius of the ipsilateral side (the piriformis
will overwork trying to substitute as an abductor) - S&S:
- Pain on climbing stairs or inclines(may run through buttocks, post
thigh and lower leg), that increases when seated for prolonged
periods, - decreased ROM in the coxa, especially medial rotation
- Pain occurs in the middle of the buttock, and achy pain can radiate
down the posterior thigh but rarely past knee. - Straight leg test with medial rotation increases pain and lateral
rotation relieves pain
coccydynia
causes
symptoms
signs
Cause: Fall on gluteals and childbirth can precipitate, Articular
and soft tissue changes (coccygeal ligamentous fibrosis, pelvic
floor spasm)
Symptoms: coccyx pain when seated, rarely refers to another
location
Signs: Indication of pain and thickening of coccygeal ligament
arthritis
causes
symptoms
signs
Cause: Previous injury to facet joints, Sustained muscle
tension, Poor posture, Muscle imbalances, Obesity
Symptoms: dull, aching pain worse in the morning, improves
with movement, Diffuse stiffness in the low back
Signs: Chronic loss of extension of lumbar, Damage to facets
Pelvis crossed syndrome
causes
symptoms
signs
- Pelvis Crossed Syndrome
- Imbalance between shortened and tight hip flexors and
lumbar errector spinae mm. and the weakened gluteals
and abdominal mm. - Results in anterior rotation of the pelvis and
hyperlordosis of lumbar spine plus minimal hip flexion - Tight mm. : Piriformis, Hamstrings, ES, QL, RF, TFL,
Iliopsoas - Weak mm.: Glute max, med. and min, Rectus
abdominus, Vastus medialias and Lateralis
What is scoliosis
lateral curvature of
the spine
What is the difference between structural and non-structural scoliosis?
Non-Structural Scoliosis
* It is also known as Functional
scoliosis
* Causes: postural problems,
muscular imbalance, nerve root
irritation, inflammation,
contracture or compensation
from leg length discrepancies
* Signs and Symptoms: back pain,
lose flexibility, side-bending stays
symmetrical, and curve will
disappear when flexing forward
at waist.
* It is usually found in the cervicals,
lumbar or thoracolumbar.
Structural Scoliosis
Causes: a bony deformity which
may be congenital, acquired or
excessive muscle weakness (long
term quadriplegia)
* Idiopathic (genetic) 75-85%
* Wedge vertebrae
* Tumours, infection that cause
bone destruction
* Hemivertebrae: one half of
vertebrae malformed
* Failure of segmentation: failure
of growth in vertebrae bones
during embryonic development
Signs and Symptoms
* lose flexibility and may become
progressive
* Curve does not disappear with
forward flexion at waist
* Seen in thoracolumbar
* Side-bending not symmetrical
* Prominence of ribs on one side
* Compression and malposition of
the organs within rib cage
* Changes to discs, ligaments, joint
capsule and muscles
* Pain in back, neck, legs, hips
What is scheuermann’s disease?
a type of structural
kyphosis. They get anterior
wedging of vertebrae.
what is spondylosis?
a degenerative disease of unknown etiology
affecting intervertebral joints and resulting in exostoses
(bone spur) and ankylosis of adjacent vertebrae.
what is spondylolisthesis
a forward displacement of one
vertebrae over another
what is retrolisthesis
backward displacement of one vertebra on
another
An ankle sprain is:
a tear or stretch of the ligature of the ankle
Which pathology presents with the feeling of walking on stones, with calluses and inflammation around the joint capsule?
foot capsulitis
This foot injury presents with pain at metatarsal heads especially during toe off in gait.
metatarsalgia
Bone Spurs are created by pulling of the plantar fascia at the attachment site on the calcaneus and/or compressive forces.
true
The ligature of the ankle that are most commonly sprained are the:
lateral collateral ligament
During gait the plantar fascia serves to bring which structures of the foot closer together?
calcaneus and metatarsals
When the bones of the midfoot are broken or dislocated with a bruise on the bottom of the foot we might suspect:
Lisfranc injury
Which tendon has ruptured when there is a loud pop sound and severe pain in the heel and into calf?
achilles tendon
The causes of plantar fasciitis are:
muscular imbalances
tibial displacements
overuse
This foot deformity involves hyperextension of the MTP joint and flexion of the PIP joint.
hammer toe
A tibial turned medially with toeing in, is called:
tibial torsion
This pathology can cause a lack of sensation in the lower extremity and lead to Charcot’s arthropathy.
diabetes
In this foot deformity clients lack a medial longitudinal arch.
pes planus
A client with Plantar fasciitis might present with the following symptoms/pain pattern:
sharp pain in the morning when first stepping down and weight bearing
Ankle sprains present with:
pain
swelling
decreased ROM
In this foot deformity the big toe is lateral and its metatarsal is medial
hallux valgus
Which motion serves to stretch the plantar fascia and increase pain for the patient?
pronation
Where do bone spurs commonly occur when someone is suffering from plantar fasciitis?
medial anterior calcaneus
In this ankle pathology the client lacks dorsiflexion because of muscle contracture or bone deformity.
ankle equinus
A complete rupture of the Achilles tendon is treated with:
surgical reattachment:
The underlying principle of pathophysiology behind a repetitive strain injury is best described as which of the following?
Localized inflammatory response
Generally, overuse injuries start with discomfort after activity, and eventually progress to pain during and after the activity is stopped.
True
Systemic pain is recognized with which of the following signs and symptoms?
Deep aching throbbing pain, interrupted sleep and is not aggravated by mechanical stress
Repetitive strain injury can be defined as an “overuse syndrome that describes pain associated with loss of function which results from repetitive movements or sustained static loading”
True
The intent of treatment is to address the musculoskeletal injuries and postural dysfunctions / imbalances.
True
This pain is described as deep, boring and localized. What is it?
bone pain
A thorough case history is important in helping determine the perpetuating cause of injury.
True
The use of procedural protocol for postural control is not applicable when dealing with a repetitive strain injury.
false
Repetitive strain injuries involve which of the following structures?
Muscles, nerves, tendons, ligaments, fascia and possibly bones
Effective treatment of a repetitive strain injury is dependent on which of the following?
Recognizing and correcting the underlying predisposing, predicting, or perpetuating factors
Client should only do passive rest when recovering from a RSI.
false
What are the risk factors for RSI
Stress, postural faults, occupation, muscular imbalances
What are the causes of repetitive strain injuries?
Muscular imbalances
Overtraining
Malalignment syndrome
A benign pituitary tumor of the pituitary gland made from prolactin secreting cells
Prolactinoma
Plasma protien that triggers coagulation and inflammation
Factor XII Hageman
Proliferative stage engaged in fibroblasts migration and cap growth
Fibroblaisa and neuro vascularization
Hyperplasia
Increase in number of cells
Endothelium contributions to inflammation
Metaplastic transformation of WBCs
In creased blood flow to cap bed due to pre-cap sphinter relaxation
Starlings equation
Blood hydrostatic pressure
Transudate is plasma Ritch in protiens
FALSE
How far cancer has spread
Stage
Malaria
Protozoa
Cause of edema
Increased intramuscular hydrostatic pressure
Bacteria
Single cell
No nucleus
Viruses
Protien coat
Nucleic acid
Type 2 hyper sensitvity
Antibodies
Autoimune in skin, joints and kidney
Systemic
Problems due to medical or therapeutic intervention
Iatrogenic
Type 1 hypersensitivity
IgE
Type 4 hypersensitivity
Granulomas
Type 3 hypersensitivity
Basement membrane
Extracellular deposit of fibillary protiens causing malfunction of the organs
Amyloidosis
Vitiligo is
Acquired
Tinea versicolor
Fungal infection
Autoimmune causing thickening of the skin and internal organs
Collagen
Scleroderma
Polycthemia vera
Erthrocytes
Wagerers granuloma
Blood vessels
Multiple myeloma
Plasma cells
Swollen red fingers with streaks
Lymphangitis
Fever and painful lymph
Lymphenitis
Buerger’s disease
Acute inflammation. And thrombosis of the arteries and veins usually in the hands and feet
Infection that damages heart valve
Endocarditis
Rheumatic heart diseas
Strep
Valvular
